MEDICARE: MS. CARRIE LYNN CROWDER ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	RT003821	PA

General Provider Information

NPI Number	:	1245295583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CARRIE LYNN CROWDER ATC

Provider Business Mailing Address
First Line	:	818 EDGEHILL DR
Second Line	:
City	:	JOHNSTOWN
State	:	PA
Zip	:	15905-2229
Country	:	US
Telephone Number	:	814-421-6614
Fax Number	:

Provider Business Practice Location Address
First Line	:	3528 ROUTE 119 HWY S
Second Line	:
City	:	HOMER CITY
State	:	PA
Zip	:	15748-1594
Country	:	US
Telephone Number	:	724-479-2231
Fax Number	:	724-479-2813

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	07/08/2007

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